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"One in ten persons over 65 and nearly half of those over 85 have Alzheimer's disease. Today, 4 million Americans have Alzheimer's disease. Unless a cure or prevention is found, that number will jump to 14 million by the year 050. Worldwide, it is estimated that million individuals will develop Alzheimer's disease by the year 05. In a national survey, 1 million Americans said they have a family member with Alzheimer's disease, and 7 million said they knew someone with the disease." (www.alzheimersassociation/treatingcognitivesymptoms.html)
What is Dementia?
Dementia is a term used to describe the loss of cognitive or intellectual function. It is a biological brain syndrome that results in cognitive impairments. It can occur as a result of a variety of neurological diseases. One of the better-known dementing diseases is Alzheimer's disease (AD). Statistically AD is the most significant dementing disease occurring in over fifty percent of demented patients. Dementia is a long-term advancing disorder. (www.alzheimers.org/pubs/prog00.html)
Nineteenth Century
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The study of dementia dates back to the early nineteenth century. The great French psychiatrist Pinel attempted the initial steps at the beginning of that century. Pinel's observations led him to the conclusion that the term dementia should be used in relation to the "progressive mental changes seen in some idiots." (www.geocities.com/bigmike_75/aessays/a48.html)
Much of today's knowledge about dementia was gathered throughout the second half of the nineteenth century, and the first decade of the twentieth century. Dr. Alois Alzheimer first described Alzheimer's disease in 106, as a degenerative brain disease that usually begins gradually, causing a person to forget recent events or familiar tasks. (www.alzheimersassociation/frequentlyaskedquestions.html)
Gender/Ethnic Differences
Dementia is known as the quiet epidemic, but it affects a large portion of our population. In 18 the Canadian consensus estimate about 50,000 cases of dementia with 5,000 new cases occurring annually. There are no significant gender differences in prevalence and incidence rates for dementia as a whole. However, for AD, there is an increased prevalence in females. It is estimated that the female to male AD prevalence ratio of 1.6. (www.geocities.com/bigmike_75/aessays/a48.html)
Ethnically there seem to be important differences in both prevalence and subtype of dementia. Out of a random sample of 4,116, sixteen percent of African Americans had dementias compared to only .1 percent of Caucasians. The same study also found that mixed (dementia with both cortical and sub cortical features, and MID is a example of mixed dementia) and Multi-infarct dementia (MID) was more likely in African Americans. (www.geocities.com/bigmike_75/aessays/a48.html)
In both Europe and North America most studies conclude that AD is the most common dementing illness; whereas in Asia MID predominates. The high rate of stroke in Japan is consistent with a high MID rate. Possibly the higher level of stress in Japan leads to more strokes and therefore a higher incidence of MID. (www.geocities.com/bigmike_75/aessays/a48.html)
Risk Factors
Many conditions cause dementia. Several other diseases also cause dementia, such as Parkinson's, Creutzfeldt-Jakob, Huntington's, and multiinfarct or vascular disease, caused by several stokes in the brain. (www.alzheimersassociation/frequentlyaskedquestions.html)
Age is the biggest risk factor for developing dementia. According to a model proposed by Jorm et al. (187) a doubling of the prevalence rate occurs every 5.1 years. For the elderly population aged 65 and above the prevalence of dementia is estimated at about ten percent. Whereas in the very elderly it can reach up to forty percent. (www.ninds.nih.gov/health_and_medical/disorders/alzheimerdisease_doc.html)
Genetic factors are important in some dementing diseases. The genetic evidence in AD is less conclusive. Farrer et al. (10) suggests that AD appears as an autosomal dominant in families in which the average onset among kindred's is under fifty-eight. Supporting evidence for this comes from studies, which have linked EOAD with Down Syndrome (DS). Individuals who are afflicted with DS and who survive to age forty almost always develop AD. (www.alzheimers.org/pubs/unravel.html)
The increased risk for AD to patients born to mothers over forty is consistent with DS risk curve. It has been proven that an increased risk for dementia is dependent on a strong chemical binding between the main ingredient of SP, the Beta amyloid protein, and the APOE-e4. (www.alzheimers.org/pubs/prog00.html)
Lower education has also been linked with dementia. Animal studies demonstrate a relation between environmental stimulation and dendritic growth. It is also known that dendritic growth in humans continues throughout life. Therefore possibly lower education is related to a lack of mental exercise, which could delay the on set of significant cognitive decline. (www.alzheimers.org/pubs/prog00.html)
Another risk factor is depression. Four studies have reported a statistically significant association between a history of depression and AD. It is thought that depression is possibly an early start of AD. (www.alzheimers.org/pubs/unravel.html)
There is also some research suggesting that individuals with a weakened immune system may be more susceptible to develop AD. Also, dementia similar to that seen in AD may occur following a single head injury. (www.neurologychannel.com/dementia/)
Memory/Language
Memory dysfunction is often considered to be the distinguishing clinical feature of AD. Therefore, it is unlikely that a diagnosis of AD will be given unless a memory deficit is present. A common example of memory dysfunction in mild dementia includes misplacement of items without independent retrieval, failure to recall details of recent events or conversations, and frequent repetition of questions. At a more advanced stage recent events are forgotten, and even knowledge of learned material erodes. It is thought that in AD, memory failure occurs as a result of improper encoding rather than due to retention failure. Orientation dysfunction usually co-occurs with a memory deficit. There are difficulties with dates, temporal sequencing, day/night distinction, and navigating through familiar places. (www.neurologychannel.com/alzheimers/)
The most common language impairment in AD patients is dysnomia, the inability to name common objects. This occurs early in the course of AD, later on expressive and receptive aphasia are often present. (www.neurologychannel.com/alzheimers/)
Treatment
As of March 001 there were four prescription medications approved by the U.S. Food and Drug (FDA) for the treatment of AD. Tacrine was approved in 1, donepezil was approved in 16, rivastigmine was approved in 000, and galantamine was approved in 001. These are known as cholinesterase inhibitors. Due to the side effects with tacrine it is very rarely prescribed. The cholinesterase inhibitors are designed to enhance memory and other cognitive functions by influencing certain chemical activities in the brain. Acetylcholine is a chemical messenger in the brain that scientists believe is important for the function of brain cells involved in memory, thought, and judgment. Acetylcholine is released by one brain cell to transmit a message to another. Once a message is received, various enzymes, including one called acetylcholinesterase, break down the chemical messenger for reuse. In the Alzheimer-afflicted brain, the cells that use acetylcholine are damaged or destroyed, resulting in lower levels of the chemical messenger. A cholinesterase inhibitor is designed to stop the activity of acetylcholinesterase, thereby slowing the breakdown of acetylcholine. By maintaining levels of acetylcholine, the drug may help compensate for the loss of functioning brain cells. (www.alzheimersassociation/treatingcognitivesymptoms.html)
Vitamin E is also prescribed with treatment in AD. The normal cell function termed "oxidative metabolism" results in byproducts known as free radicals. These are highly reactive compounds that quickly "attack" other cell substances, causing damage to the cell wall, metabolic machinery, and genetic material (DNA). The cells have natural defenses against this damage, which include the antioxidants vitamins C and E, but with age some of these protective mechanisms decrease. Brain cell damage caused by free radicals may play a role in AD. (www.alzheimersassociation/treatingcognitivesymptoms.html)
Vitamin E works as well as selegiline (a drug with antioxidant properties, used in treating Parkinson's Disease) on AD progression, it is considered to be a benign" medication without any side effects and it costs less. Therefore it is preferred over selegiline in AD treatment. (www.alzheimersassociation/treatingcognitivesymptoms.html)
Side Effects of the Prescription Medications
Symptoms such as nausea, vomiting, loss of appetite, and increased frequency of bowel movements might be expected with any cholinesterase inhibitor. There is no evidence or reason to believe that combining the drugs would be any more beneficial than taking either one alone, and it is likely that combining the drugs would result in greater side effects. (www.alzheimersassociation/treatingcognitivesymptoms.html)
Cost for Caring for a Patient with AD
According to a recent study in northern California, caring for a patient with AD costs more than $47,000 a year whether the person lives at home or in a nursing home. This study found that families of AD patients living at home spend about $1,000 annually, per family, for formal services. But when the researchers added the estimated cost of unpaid, informal care provided by family members, the total annual cost was $47,04 comparable to the cost of nursing home care. (www.alzheimers.org/pubs/unravel.html)
Emotions/Behavior
As AD alters memory and mental skills, it also begins to alter emotions and behavior. An estimated seventy to ninety percent of Alzheimer's patients eventually develop behavioral symptoms. One of the most common is agitation. In addition to agitation, Alzheimer's patients often experience feelings of anger, frustration, and depression. The disease can lead to wandering, pacing, and screaming. These symptoms of the disease and their effects on the family are thought to be one of the most common reasons that Alzheimer's patients are institutionalized. (www.alzheimers.org/pubs/unravel.html)
Who are family caregivers?
Researchers have found that the greatest number of family caregivers is wives and husbands; daughters come next. Many caregivers are single women. Researchers are now studying the experiences of caregivers from various ethnic and racial groups to see if their approaches to caregiving differ. According to several studies, African American caregivers, are less likely to see care giving as a burden and more likely to share it with a large number of extended family members, when compared to white caregivers. Scientists are exploring these differences to see if they can pinpoint the coping strategies or other factors that affect how different racial and ethnic groups perceive care giving. (www.alzheimers.org/pubs/unravel.html)
Emotional Support
One major hypothesis is that social support can help reduce stress and other care giving problems. Support groups, individual counseling, and family counseling all fall into this category, and they are being studied in various ways. To date, studies have generally shown a high level of satisfaction with support groups, although it is not clear whether they also help decrease caregivers' sense of burden. Individual counseling has alleviated specific problems such as depression. (www.alzheimers.org/pubs/unravel.html)
Services
Help from community groups or professionals is another way to ease the difficulties caregivers face. Probably the most common service, and the most studied so far, is respite care. Respite services are offered in the home, in day care facilities, and even in institutions where patients stay a limited times, usually a week or two. So far studies of respite care show a very promising benefit, and current research is looking for ways to increase its impact. (www.alzheimers.org/pubs/unravel.html)
Institutional Care
While finding services to help with family care may be difficult, Alzheimer's families say that the decisions surrounding placement in a nursing home can be even harder. Whether and when to turn to a nursing home is the first and some say the most difficult decision. (www.alzheimers.org/pubs/unravel.html)
How is AD diagnosed?
There is no single, comprehensive diagnostic test for AD. Instead, physicians or other specialists rule out other conditions through a process of elimination. They usually conduct physical, psychological, and neurological exams and take a thorough medical history. A diagnosis of possible AD can be obtained through evaluation with approximately 0 percent accuracy. The only way to confirm a diagnosis of AD is through autopsy. (www.alzheimersassociation/frequentlyaskedquestions.html)
How does AD Progress?
AD causes the formation of abnormal structures in the brain called plaques and tangles. As they gather in affected individuals, nerve cell connections are reduced. Areas of the brain that influence short-term memory tend to be affected first. Later, the disease works it way into sections of the brain that control other intellectual and physical functions. (www.alzheimersassociation/frequentlyaskedquestions.html)
AD affects people in different ways, making it difficult for medical professionals to predict how an individual's disease will progress. Some experts classify the disease by stage (early, middle, and late). But specific behaviors and how long they last vary greatly, even within each stage of the disease. (www.alzheimersassociation/frequentlyaskedquestions.html)
AD can occur in people in there 0s, 40s, and 50s. However, most people diagnosed with AD are older than 65. The early onset form of the disease that strikes younger people accounts for less than 10 percent of all reported cases. Scientists believe this variation of the disease may be genetically transmitted across multiple generations of the same family. (www.alzheimersassociation/frequentlyaskedquestions.html)
What is being done to find a cure or prevention?
Alzheimer research is being tackled from many sides. Pharmaceutical companies, the U.S. federal government, and the Alzheimer's Association are funding research to learn more about the disease process and to find compounds that will alleviate symptoms and prevent or cure the disease. (www.alzheimersassociation.com)
Incidence study of dementia and AD
The incidence of dementia and AD is significantly lower among Nigerian Africans and African Americans according to results of a five-year study published in the Journal of the American Medical Association. Dr. Hugh C. Hendrie, of Indiana University School of Medicine, in Indianapolis, and associates conducted a prevalence study between 1 and 1. Approximately two and five years later, they reevaluated these two populations for new cases. Included were ,45 residents of Ibadan and ,147 residents of Indianapolis. All of the subjects were 65 years or older and did not have dementia at baseline. (www.neurologychannel.com)
The subjects were assessed using the Community Screening Interview for Dementia, in which the subject undergoes a cognitive assessment and there is an interview with a relative. Incident dementia was documented in 117 African Americans and 70 Nigerians. Age-standardized, annual incidence rates for dementia were 1.5% for the Nigerians and .4% for the African Americans. Corresponding rates for AD were 1.15% and .5%. (www.neurologychannel.com)
They found a significant association between possession of the epsilon-4 allele of the apolipoprotein E gene and AD in African Americans, but no significant association among Nigerians. The variation in the strength of the association between epsilion-4 and AD may account for some of the differences in incidence rates between the populations. (www.neurologychannel.com)
Personal Experience
I have a personal experience with AD. My grandfather is 8 years old. He has AD. We daily face him not knowing who we are, him asking us the same questions over and over, him not remembering where the bathroom is (so he uses the bathroom outside), him having mood swings, etc. Looking at videotape we recorded years ago shows a significant change in my grandfather's ability to function. Not only is his mind shutting down, but society also is shutting him out. Just the other day we took him to church. He was laughing throughout the sermon and we were escorted out of the church. I could not believe that we were kicked out of church. We need to focus and put forth more effort toward research on this disease.
This assignment was very difficult due to little information and research on ethnic minorities. My original topic was African American elderly and education. With that topic I could not find any information on African American elderly. Therefore I changed my topic to ethnic minority elderly and dementia diseases. Also with this topic I found very little information on specific information on ethnic minorities. I searched all possible avenues that I knew of and I found very little and limited information for this assignment.
Conclusion
Over the past few decades, Alzheimer's disease has emerged from obscurity. Once considered a rare disorder, it is now recognized as a major public health problem having a sever impact on millions of Americans and their families. AD proceeds in stages, gradually destroying memory, reason, judgment, language, and eventually the ability to carry out even the simplest of tasks. AD is a progressive disease, the symptoms growing worse with time. Symptoms progress at different rates and in different patterns. Thus one patient may begin to have problems with muscular coordination earlier than another or retain some memories longer. As the human race moves forward, one of the challenges that will remained to be solved is the dementia epidemic. The continuous increase in life span means that the number of people that are afflicted with dementia will continue to rise.
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